The investigation of biomarkers in cardiovascular disease: time for a coordinated, international effort

Abstract

This editorial refers to ‘Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcome. An ENTIRE-TIMI 23 substudy’† by K.K. Ray et al ., on page 440 Biomarkers may be defined as measurable cells, proteins, and/or metabolic by-products that represent, either directly or indirectly, one or more biological or pathological processes active within a defined system or disease state. In a majority of cases, biomarkers delineate variances from normal biology and either appear for the first time (newly expressed) or, more commonly according to traditional thinking, elevate beyond a normal range in response to one or more stimuli or pathologic events [e.g. cardiac specific troponin in acute myocardial infarction (MI)], rendering a clinical diagnosis; however, biomarkers may themselves participate actively in the subsequent evolution and expression of disease (e.g. C-reactive protein in atherothrombosis). Thus, biomarkers, considered collectively and functionally, serve as diagnostic aids (type I), prognostic indicators (type II) and, perhaps more often than previously realized, fundamental contributors to the pathobiological basis of disease (type III) (types I–III are examples of a biomarker classification or categorization scale). In the article by Ray et al. ,1 von Willebrand factor (vWF) is considered as a biomarker of the type II and III categories.1 The ENTIRE-TIMI 23 Investigators1 evaluated enoxaparin, a … *Corresponding author. E-mail address : becke021{at}mc.duke.edu